Our practice recently saw three patients on the same day who had all sustained Achilles tendon ruptures. The three injuries occurred while playing basketball, but each one was unique, so the treatments varied. Here’s a look at the three different injuries and the treatments that were used.
Complete Achilles Tendon Rupture — Immediate Presentation
The first rupture was complete and was treated through a minimally invasive surgical approach. There are pros and cons to both the conservative treatment of Achilles tendon ruptures and surgical management of Achilles tendon ruptures. A thorough assessment is mandatory for these injuries to determine which course of action is most appropriate for the patient. If surgery is recommended, if, at all possible, a minimally invasive approach will be performed. This decreases the size of the incision and can potentially decrease the risk of postoperative healing issues, infection, and other complications occurring.
A minimally invasive approach to Achilles tendon repair can be achieved through a 2 cm incision. Classically, more traditional incisions were on the order of at least 10 cm in length. An instrument called the percutaneous Achilles repair system (or PARS for short) allows for the predictable insertion of the suture material into the Achilles tendon to allow for a sturdier, more predictable repair.
Check out a video outlining the minimally invasive approach here.
A conservative approach to Achilles tendon repair can be considered in patients that wish to avoid surgery. It is mandatory for close apposition of the tendon ends to be present because otherwise, the tendon will heal in a lengthened position which will only lead to weakening and decreased push-off strength, and lower athletic performance.
Rupture in the aponeurosis — closer to the calf muscle
The second rupture occurred higher up by the muscle and was treated with a short course of physical therapy and immobilization. This was a very straightforward recovery for the patient.
Complete Achilles Tendon Rupture – Delayed Presentation
The third rupture was the most challenging to treat because the patient did not seek medical attention until three months after the injury. A complex surgical repair had to be performed.
An MRI was obtained before surgery and revealed a large defect between the 2 ends of the rupture. At the time of surgery, the ruptured ends possessed a significant amount of scar tissue that had to be cut away. This leaves an even larger defect. To approach this repair, the flatter tissue that eventually gives rise to the Achilles was cut in a fashion that allowed it to be rotated down and turned into a new Achilles tendon. This was attached to the stump of the Achilles which attaches to the heel bone/calcaneus.
In addition to this, to further stabilize and increase strength, a procedure known as an FHL tendon transfer was also performed. With an FHL tendon transfer, the tendon known as the flexor hallucis longus tendon was detached from an area in the back of the ankle and rerouted into the heel bone. So, instead of this tendon causing plantar flexion of the big toe, instead, it now caused plantarflexion at the level of the ankle joint. As it sounds, this is a more complex surgery and the recovery can be more protracted as well.
If you sustain an Achilles tendon rupture, it’s important to seek medical attention as soon as possible so that an accurate diagnosis can be made and appropriate treatment can be administered. Treatment will vary depending on the individual case, but early intervention is key to a successful outcome.
